Toxtalk Virginia Division Offorensic Sciences 1 North 14 Th St

Society of Forensic Toxicologists, Inc. P. O. Box 5543, Mesa, AZ 85211-5543 PhonelFax 602-839-9106

PRESIDENT

JOHpb J. Saady, Pb.D. DABFT ToxTalk Virginia Division ofForensic Sciences 1 North 14 th St. Richmond. VA 232t9 IVOLUME 22, No.2 JUNE 19981 Tel 804-786-9151 Fax: 804-371-8328 EDITOR: Joseph R. Monforte, PhD, DABIT Email : [email protected] EDITORIAL BOARD: H. Chip Walls, B.S., Jim Wigmore, B.Sc., Daniel lsenschmid, Ph.D., DABIT. Vincent Papa, Ph.D. PUBLISHER: Patricia Mohn-Monforte

VICE PRESIDF:NT

Marilyn A. Huestis, Ph.D. LabofChem & Drug Merabolism IN THIS ISSUE ______~_ Addiction Research Center NIDA. NIH 5500 Nathan Shock Dr. Baltimore, MD 21224 REGULAR FEATURES: Journal Club ~ Professional Calendar ~ Career Opportunities ~ Tel : 410-550-2711 From the Editor's Desk ~ Elmer Gordon ~ Drugs in The News ~ President's Message Fax: 410-550-2468 Email : Mlluestis(~ irp . nida . nih.gov TECHNICAL NOTES: Blutalkoholkonzentration ~ CASE NOTES: Comparison of Post mortem Heart and Peripheral Blood Ethanol Concentrations (IsenschmidlHepler). Vitreous Humor SECRETARY 6-Acetylmorphine (SaadylEnglandlValentour), and Strikingly High Concentrations of THCA in Urine: Misapplication of "Medicinal Marijuana" Through Improper Self-Diagnosis and Dosing? (Dunn) Mirbael L Smitb, Ph.D., DABFT ~ ed Forces Medical Examiner, AFIP ·ashington. DC 20306-{)OOO OF SPECIAL INTEREST: Interim SOFT Board Meeting ~ SOFTffIAFT '98 • el : 301-319-0100 Fax: 301-319-0628 INSERTS"': '98 SOFTffIAFT Meeting Materials Email : [email protected]

TREASlJRER F~OH THE. £1)"O~'S DE.SK , , .. Joseph R. Monforte, Ph.D., DABFT

J. Ro~rt Zeltl, U.s., M.P.A. Forensic Alcohol Consulrants. Inc. On page 9 of the previous issue of ToxTalk ( Volume 22, March 1998) there 1500 E. Mineral Place Linlelon. CO 80122-2911 appeared a summary of an article entitled "Marijuana and Actual Driving Performance," Tel 303-795-1654 submitted by Art McBay. The ToxTalk article incorrectly stated that driving tests were Fax : 303-795-1654 conducted in city traffic and on highways at speeds up to 26 miles per hour. It should have Email : JRZETTL(lilEC ENTRAL.COM stated that the driving tests were conducted at speeds up to 62 miles per hour. Please note the correction. ~ ADDITIONAL DIRECTORS

Brure Gold~rger. Ph.D. VISIT THE SOFT WEBSITE: www.soft-tox.org Laurel J. Farrell, B.A. Daniellsensrhmid. Ph.D., DABFT Amanda Jenkins, Ph.D. Thomas F. Simon irk., B.S. ToxTalk is mailed quarterly (bulk mail) to members of the Society ofForensic Toxico logisfs. ex offido: Virkie W. Walls, M.S. Inc. It is each member's responsibility to report changes of address to the SOFT mailing address Joseph R. Monforte. Ph.D., DABFT (Mesa, AZ - above). Non-members may now receive ToxTalk for $15 per calendar year. Make (ToxTalk Editor) your check payable to SOFT, and mail it to the ToxTalk Editor. All members and others are encouraged to contribute to ToxTalk. Please mail your 1998 ANN{ IAL MEETING HOSTS contribution to : Joseph R. Monforte, Ph.D., DABFT, ToxTillk Editor N.G.S. Rao, Ph.D. I Ronald Barker, Ph.D. I .--" Vina Spiehler, Ph.D. 42408 N. Sombrero Rd, Cave Creek, AZ 85331-2821 0). Box 40711 Telephone: 602-595-MOHN (6646) Fax: 602-595-MONF (6663) - nfter 11 n.m. E.s.T. plense ."\Ibuquerque. NM 87196-071. I E-mail: [email protected] Tel: 505-841-2562 Fax: 505-841-2543 Email: [email protected] DEADLINES: Feb. 1, May 1, Aug. 1, and Nov.!. NEXT DEADLINE: August J, J998 SOFf is a supporting organization of the American Board of Forensic Toxicology PRESIDENT'S MESSAGE by Joseph Saady, Ph.D., DABFT

THE ROOM CRUNCH

We are running out of rooms for the SOFT Annual Meeting in Albuquerque. The Hilton is sold out, and the Fairfield is 50% sold out. The local committee in Albuquerque has obtained the maximum number of rooms from the hotels during this busy week. Reserve your room now, if you wish to attend!

II EMPLOYMENT IN TOXICOLOGY - THIS MAY BE AS GOOD AS IT GETS

If you expect that I have performed a thorough analysis of this subject, then read no further! I have not! But I do have colleagues throughout this country who have discussed their situations and tribulations related to this issue with me. As one who has changed employment within the past two years, I wish to reflect on this issue.

Corporate downsizing, realignment, re-engineering, restructuring, consolidation, merger, etc. All of these synonyms mean one thing . Employees lose their jobs and thus their lives are disrupted. The remaining employees work longer hours and harder to "take up the slack." The remaining employed are acutely aware of the very real possibility of losing tlliill job and are, therefore, under greater mental stress to perform better and for longer hours. Work pressures are consuming more of our lives. Let's face the reality. As professionals, an attack on our work, our job, our livelihood goes to the very core of who we are .

The workplace has changed! It has not been that many years ago when employers had a sense of responsibility and protection for the employee. Employees on the other hand had a sense of loyalty and dedication toward the employer. These ideas are more of the exception than the rule now. Exceptional work is frequently rewarded with additional burdens, for little or no additional monetary compensation. We are reading in the news that there are currently more people employed than ever before. But for toxicologists, it appears that the salaries are weak, and that there are more lower paying jobs. Actually many other professions and industr~ are experiencing simi'lar effects - with the exception of computer related jobs.

What can toxicologists do to protect themselves? Learn! And learn constantly over your lifetime. Tackle tough prob:ems, and find solutions. Create a situation where the employer needs you more than you need them . If you have experience and have a demonstrated ability to solve problems, you are a valuable asset to any company. Your reputation , the manner in which you conduct yourself, your resume' , your skills and problem solving ability will stay with you . As companies outsource labor, many of our toxicologists have taken advantage of this opportunity in consulting services. Still others are finding ways to creatively use their toxicology background in forensically related fields.

The Visioning Workgroup 1998 is now investigating (to the extent possible) the future of forensic toxicology. What are your ideas? Contact Dr. Carl Selavka at [email protected] or by fax at (518) 457-9384.

And try to enjoy your job. This may be as good as it gets! ~

PRESIDENT SAADY ENCOURAGES YOUR INPUTI You may. .. E-mail , fax, or write to Joseph J. Saady, Ph.D., DABFT Virginia Division of Forensic Sciences, 1 North 14th Street, Richmond, VA 23219 e-mail at [email protected] fax to 804-371-8328

REMINDER TO SOFT BOARD MEMBERS AND COMMITTEE CHAIRS

The SOFT Board Meeting will be held Tuesday, October 6th, at 6: 30 p.m. Report forms and more specific information will be distributed. Please make every effort to submit your report by the stated date. For further information, contact President Saady. ~

This may be your last opportunity to make hotel reservations for the SOFTITIAFT meeting. Space is very limited ---- j will be reserved on a "first come" basis only. To qualify for conference rates specify "SOFT" when making your

I c:servations. Rates are not guaranteed after September 3rd . A third hotel has been added to try to accommodate attendees. Local phone numbers are listed below, the 800 national contacts may not recognize your SOFT discount.

Albuquerque Hilton (Congress Hotel) 505-884-2500: $105 single/double; $115 triple; $125 quad Fairfield Inn by Marriott (same compound as Hilton) 505-889-4000: $89 single/double; $99 triple; $109 quad Holiday Inn Mountain View (across the parking lot from the Hilton): 505-884-2511 $99.95 single/double; $109.95 trip/quad

Here are some important deadlines to remember: July 1st Abstracts must be submitted July 1st Free t-shirt with registration Aug . 1st Early registration. $50 late fee applies after this date Sept. 7th Last day mail registrations will be accepted Sept. 3rd Hotel reservation rate. guaranteed (but NOT room space)

This year, you have two registration options. The basic difference between the Mesa and Sandia registrations is that the Mesa does not include the following: Wednesday and Friday luncheons, Farewell Banquet, Workshop #6, and the published Congress Proceedings. Additional information can be obtained by writing to:

SOFT-TIAFT 1998, POBox 40711, Albuquerque, NM 7196-0771

or contact: N.G. Rao (SOFT) Phone: 505-841-2562 e-mail: [email protected] .us (THIS IS NEW) Ron Backer (SOFT) 915-561-8851 [email protected] Vina Spiehler (TIAFT) 714-642-0574 [email protected]

Report of Interim Meeting of the SOFT Board of Directors

Submitted by Michael L. Smith, Ph.D., DABFT, SOFT Secretary

President Joseph Saady presided over the meeting held February 11 , 1998, in San Francisco, CA, during the annual meeting of the American Academy of Forensic Sciences. Committee reports were given and are highlighted. Kurt Dubowski 's Bylaws report indicated that there were no new bylaws since the last meeting and that a complete set of bylaws will be available soon in hard copy and electronic format. Marilyn A. Huestis, last year's secretary, announced that SOFT added 78 new members in 1997 bringing total membership to 562; 25 charter, 420 full, 88 associate, 19 retired and 10 student members. 1998 Secretary Michael Smith reported that Dr. Kenneth Sun has replaced Deb Rector on the membership committee. Joseph Monforte, ToxTalk editor, reviewed journal deadlines then thanked editorial staff; Chip Walls for "The Journal Club", Jim Wigmore for "Blutalkaholkonzentration", and Dan Isenschmid for "Case Notes". Vince Papa will soon introduce a new section called "Drugs in the News." Brad Hepler and Dan Isenschmid, co-editors for the 1998 SOFT/Journal of Analytical Toxicology Special Issue, indicated that some manuscripts were already received and that deadlines were Mar 9 for abstracts and Mar 23 for completed papers. The Board approved up to $7500 to assist with publication. H. Chip Walls, chair of the Drugs & Driving Committee, announced that the Benzodiazepine monograph is in final form and a Methamphetamine monograph by Barry Logan is underway. JCETT requested money to fund the lending library and web-site. The board recommended that a clear concept of the library and web-site be developed and then presented at the next board meeting. Bruce Goldberger, chair of the SOFT Web-site committee, announced that upcoming features of the web-site would be to include "Introduction to Forensic Toxicology" by Baselt & Cravey in the site, educational links to other resources and a link to an employment exchange. Hosts or their representatives presented plans for future meetings. The Board approved future meeting plans and locations. The list of locations and hosts are as follows: 1998 Albuquerque, NM, N.G.S. Rao, Ron Backer, Vina Spiehler ..£:(IAFT representative); 1999 San Juan, Puerto Rico, Flor Mattos (represented by Luz Droz and Rosa De Jesus); 2000 waukee, WI, Steve Wong; 2001 New Orleans, LA, Pat Pizzo; 2002 Detroit, MI, Dan Isenschmid and Brad Hepler. Workshops for the 1998 meeting will be listed in the next ToxTalk. Two special features of the meeting will be a seminar on herbal medicines and the International Balloon FestivaL Rooms reserved to date were 160 with 290 remaining. Hosts strongly encouraged early reservations. After completion of committee issues, the Board met in closed session to discus ~ additional business. ~ Case Notes: VITREOUS HUMOR 6-ACETYLMORPHINE

Submitted by Joseph J. Saady, Ph.D., DABFT, Terry M. England, BS and James C. Valentour, PhD, DABFT, Virginia Division of Forensic Science, 700 North Fifth Street, Richmond, VA 23219

Frequently, heroin users are found dead at varying times after using the substance. There is seldom any history associated with such deaths and "eye witnesses" are rarely found. The medical examiner submits biological tissues to the forensic toxicologist in the hope that toxicological findings will enable the determination of the cause of death. In blood specimens, the forensic toxicologists can rarely detect the parent drug heroin because of the rapid metabolism. 6-Acetylmorphine (6-AM) is sometimes found, but the metabolite morphine is found most often (Goldberger, 1993; Jenkins, 1994). Blood morphine concentrations vary considerably in cases of death (Richards,1976). Documentation of heroin use by finding 6-AM would facilitate the Medical Examiner in determining the cause of death. Recently, Jenkins showed that the use of cerebrospinal fluid enabled the identification of 6-AM in 30 of 65 cases where 6-AM was not identified in the corresponding blood specimen (Jenkins, 1998). Preliminary data in our study (Table 1) demonstrate that vitreous humor (VH) 6-AM determinations provide a more sensitive heroin marker than the corresponding blood specimen. The table compares cases in fourteen deaths where morphine blood and VH concentrations range from 0.01 to 0.61 mg/L and 0.01 to 1.1 mg/L, respectively. 6-AM concentrations in blood and VH ranged from not detected (nd) to 0.03 and nd to 2.0 mg/L, respectively. 6-AM was identified in blood in 5/12 cases (42%) and in VH 9/12 (75%). Case K was a documented overdose of morphine sulfate tablets (MS Contin). All deaths were purported to be drug related. We are continuing to collect data on VH 6-AM concentrations.

References: Richards, R., Reed, D. and Cravey, R., Death from intravenously administered narcotics: a study of 114 cases, J. Forensic Sci. 21 :467-482, 1976. Jenkins, A. and Lavins, E., 6-acetylmorphine detection in postmortem cerebrospinal fluid, J. Anal. Tox. 22:173-175, 1998. Goldberger, B., Darwin, W., Grant, T., Allen, A., Caplan, Y. and Cone, E., Measurement of heroin and its metabolites by isotope-dilution electron impact mass spectrometry, Clin. Chem 39:670-675, 1993. Jenkins, A., Keenan, R., Henningfield, J. and Cone, E., Pharmacokinetics and pharmacodynamics of smoked heroin, J. Anc.. Tox. 18: 317-330, 1994. ~

MORPHINE 6-AM TABLE 1. VICTIM BLD VH BLD VH A 0.16 0.01 0.03 0.04 Concentrations found in blood (BLD) B 0.01 0.02 nd nd and vitreous humor (VH) expressed C 0.12 0.02 0.01 0.03 in mgfL D 0.04 0.03 nd 0.01 E 0.02 0.01 nd nd F 0.04 0.01 nd nd G 0.05 0.02 0.01 0.03 H 0.22 0.46 nd nd I 0.02 0.04 nd 0.02 J 0.05 0.04 nd 0.01 K 0.61 0.05 nd nd L 0.19 0.02 0.01 0.03 M 0.08 0.10 nd 0.02 N 0.08 1.1 0.01 2.0

MEETING REGISTRATION NOTICE Subtitle: Don't blame us later if you don't read this!

ARE YOU WAITING FOR THE NEXT ISSUE OF TOXTALK BEFORE MAILING YOUR SOFTITIA' MEETING REGISTRATION FORM? TAKE NOTICE - IT WILL COST YOU $50 MORE. (The next issue will be mailed after the August 1st deadline for early registration. So why wait? And don't forget the free T-shirt for registrations received by July 1st. ~

ToxTalk "oillme 22, No.2 Jun" 1998 (pag" 4) Copyright 1998 Case Notes: Strikingly High Concentrations of THCA in Urine: Misapplication of "Medicinal Marijuana" Through Improper Self-Diagnosis and Dosing?

/bmitted by: Connie D. Dunn, Ph.D., Air Force Drug Testing Laboratory, Brooks A.F.B., TX 78235

Controversial legislation regarding distribution of marijuana for medical use through "cannabis clubs" was debated and passed in California and Arizona as Propositions 215 and 200, respectively. Studies have indicated medicinal value for marijuana. This was followed by a plethora of articles in popular literature touting marijuana's medicinal use. Consequently, marijuana and synthetic marijuana medications such as dronabinol or Marinol may be prescribed as an antiemetic for patients suffering from severe nausea and appetite depression as a consequence of chemotherapy or AIDS wasting syndrome. Proponents for medicinal marijuana have suggested its use as a treatment for glaucoma, and due to analgesic and antispasmotic properties, migraine headaches, multiple sclerosis, arthritis, or several other illnesses. This undercurrent Of. support for marijuana may lead to misapplication through improper self-diagnosis and dosing. A white male age 19 selected randomly for urine drug testing under Department of Defense (000) urinalysis protocols (1,2,3) produced urine samples that revealed the presence of cannabinoid metabolites. Subsequent GC/MS confirmation testing demonstrated the metabolite 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THCA) in his urine at levels well above the 000 positive cutoff level of 15 ng/mL. Three samples were collected under the applicable DoD test protocols. The first sample was collected under the "random test" protocol. This sample was positive for the presence of THCA at a level of 304 ng/mL. The second sample was collected thirteen days later under "voluntary" protocol (as part of an investigation of possession/use of marijuana in his military dormitory). This sample was positive for THCA at 1713 ng/mL. A final sample collected 14 days later under the "random" protocol was also positive for THCA at 6533 ng/mL. These results are unusually high. When questioned, the individual reported that he smoked the marijuana frequently for "medical reasons" as a self-treatment for nausea (including uncontrollable vomiting). He sought formal medical treatment for extreme fear, stress, and anxiety that he felt triggered the nausea. [He did not report marijuana use initially while discussing his symptoms.] Treatment protocol was psychotherapy and a regimen of three drugs: Prozac (Fluoxetine Hydrochloride), Paxil (paroxetine hydrochloride) and Klonopin (clonazepam). Despite these interventions, the individual felt no relief from his chief complaints of panic, anxiety, nausea and weight loss of 15 pounds. After evaluations by both psychologists and psychiatrists, he was --'3gnosed with Panic Disorder with Agoraphobia, and Cannabis Abuse per DSM IV criteria .(4) The Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV) notes that when taken in high doses, "... cannabinoids have psychoactive effects that can be similar to those of hallucinogens ... and individuals who use cannabinoids can experience adverse mental effects that resemble hallucinogen-induced "bad trips." These range from mild to moderate levels of anxiety ... to severe anxiety reactions resembling panic attacks ... " (5)

1. Department of Defense Directive 101 0.1, Military Personnel Drug Abuse Testing Program. 2. Department of Defense Instruction 1010.16, Technical Procedures for the Military Personnel Drug Abuse Testing Program. 3. Air Force Instruction 44-120 Medical Drug Abuse Testing Program. 4. Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV) of the American Psychiatric Association, Donnelley & Sons, 1994. 5. Ibid.

The author gratefully acknowledges support and advice provided by Amy Dreifus, J.D. and Vincent Papa, Ph.D. The opinions expressed herein are strictly those of the author and are not to be construed as reflecting the views, policies, or positions of the Department of Air Force, the Department of Defense, or the U.S. Government. ~

!vour case note should be about :ag~~~~n~m~e~a~~I~~e.~~r~~~diSk (preferably using Microsoft WorkslWord 4.0) may be mailed or faxed to:

Joseph R. Monforte, Ph.D., DABFT, ToxTalk Editor, 42408 N. Sombrero Rd ., Cave Creek, AZ 85331-2821. Or fax: 602-595-MONF (6663). The e-mail address is : [email protected]

Other items of interest to SOFT members are also welcome. Next deadline: August 1, 1998

'fn~'f"I" Fnlu...p 22. Nfl. 2 .June 1998 (Pa!!e 5) Cop}Tight 19n Case Notes: Comparison of Postmortem Heart and Peripheral Blood Ethanol Concentrations Submitted by: Dan Isenschmid, PhD and Bradford Hepler, PhD

In 1987 Prouty and Anderson published a report comparing postmortem heart and femoral blood ethyl alcohol concentrations (J. Anal. Tox. II: 191-197). We recently performed a similar study on a total of 68 fluoridated heart blood and peripheral (venous) blood specimens which had a mean ethyl alcohol concentration at or above 0.05 (% w/v) in order to confirm the earlier reported findings at our office. All analyses were performed in duplicate using standard GC headspace procedures. Ethyl alcohol concentrations were compared in these specimens using both four and two decimal places (reported value). All data was truncated at the last integer. The findings of this study are summarized in Table I and Figure I.

Table I: Peripheral Blood Ethanol Concentrations Compared Against Heart Blood Ethanol Concentrations (N= Number) I 1 Deci- N (%) N (%) N (%) N (%» N (%) > N (%) < N (%) = Mean % Mean % Dift". mals within within within 20% I Heart Heart Heart Diff. (excluding 10% 15% 20% Conc . Conc. Conc. (N=68) cases > 20%) I 4 51 (75%) 60 (88%) 63 (93%) 5 (7 .3%) 28 (41%) 40 (59%) N/A +0.36 -0.98

I 2 50 (74%) 58 (85%) 62(91%) 6 (8.9%) 21 (31%) 26 (38%) 21 (31%) +1.48 +0.42

The mean percent difference in peripheral bJood concentrations for all cases studies was <2.0% regardless of decimal places used. If cases where heart and peripheral blood concentrations differing by more than 20% were excluded, the % difference \vas less than I%. Although peripheral blood concentrations were less than heart blood concentrations in a slight majority of cases, the mean percent difference did not suggest any biases.

Figure I: Percent Difference in Peripheral Blood Ethanol Concentrations Compared With Heart Blood Ethanol Concentrations

+(>20%) ~ I

+(15-20%) -.-::l -c ---I l! +(10-15%) CD 1--1 _._ "C +(5-10%) rn I Q) :::c +(0-5%) ,gE 0% Q) -(0-5%) u c:: -(5-10%) - ____-1-.. __ _ ~ ~o -(10-15%)

"#. -(15-20%) .. 2 decil"flals - . . -(>20%) _ 4 decimals • ------i--- J 0 5 10 15 20 25 Number of Occurances

In cases for which reported heart and peripheral ethyl alcohol concentrations differed by more than 20% vitreous humor and urine ethyl alcohol concentrations were compared to both blood specimens. These findings are summarized in Table 2. Blood specimens marked with an asterisk (*) appear to be most consistent with vitreous humor and/or urine ethyl alcohol concentrations based on previously established vitreous humor and urine to heart blood ratios of 1.1 and 1.3, respectively. If no asterisk appears a determination could not be made . None of these cases involved trauma. Peripheral blood volumes collected in cases 3-6 were between 4 and 7 mL suggesting that some salting out and/or evaporation may have occurred. However, no pattern could be established that would suggest one blood specimen is preferable over another based on comparison with vitreous humor and/or urine ethyl alcohol concentrations based on the small population of discrepant blood specimens. No attempt was made to determine the absorptive state of ethyl alcohol in the decedent.

The data from this study suggests that either heart blood or peripheral blood are suitable for postmortem analysis and that both specimens do not need to be assayed routinely. The data does not support that one specimen is preferable over another. However, blood specimens collected t,'OIn two different sources may result in one blood specimen providing meaningful results when the quality of the other blood specimen is called into question.

ToxTalk I 'nlllme 21, No.2 June 1998 (PileI' 6) rJlnvrioht 1QQS! Table 2: Comparison of Data in Cases Where Differences in Heart and Peripheral Ethyl Alcohol Concentrations Exceeded 20% Case I 2 3 4 5 6

- Heart. Blood . 14 .08 * .10 .36 * . 14 .08

Periph. Blood . 18 * . 17 .06 .21 . 11 .03 *

Vitreous Humor .22 .10 .08 .39 . 14 .02

Urine .22 .09 .12 .35 . 18 nla

Cause of Death multiple drug smoke and soot heroin toxicity ASCVD and smoke and soot hypertroph ic intoxication inhalation acute alcohol inhalation cardiomyo intoxication pathy I' Manner of Death accident accident acc ident accident accident accident '" (see discussIOn)

"DRUGS IN THE NEWS"

submitted by Joseph R. Monforte, Ph.D., DABFT

In April, 1998, Smith Kline Beecham released workplace drug testing statistics for nearly 5 million specimens tested in calendar year 1997. Five per cent of the specimens tested positive, compared to 5.8 per cent in 1996. Marijuana was detected in 60 per cent of the positive specimens, an increase from 54 per cent in 1996; cocaine was detected in 17 per cent of the positive specimens, a decrease from 23 per cent in 1996.

Send your material for "Drugs in the News" to ToxTalk. ~

ABFT NEWS

The Annual ABFT Breakfast will once again be held during the SOFT Annual Meeting on Thursday Oct. 8th. The latest registration form includes this event. If you have already registered for the meeting, please complete another form for the breakfast only. New certificants and those certificants who have successfully requalified will be presented certificates at this event. Only persons currently certified by ABFT may attend. For further information contact ABFT President Yale Caplan (e-mail: [email protected]; phone: 410-486-7486; fax: 410-653-4824) . Congratulations to Philip Kemp, Ph.D., DABFT (Chief Toxicologist, Office of the Medical Examiner - State of Oklahoma, Oklahoma City) who successfully completed the required examination in February and qualified for certification by the American Board of Forensic Toxicology as an ABFT Toxicologist (Diplomate). To date, the following ABFT Diplomates have successfully requalified in 1998: Stuart Bogema , Daniel Brown , Donna Bush , Joyce Chang, Donald Hoffman, Reng-Lang Lin , Fred McClure III, Angela Springfield, John Vasiliades, Wagdy Wahba, and Mark Young. New certificates will be presented at the ABFT Annual Breakfast. The ABFT Laboratory Accreditation Program has certified a fourth Medical Examiners' laboratory: Erie County, Buffalo, NY - Dr. Robert Osiewicz. To receive specific laboratory accreditation information, please contact the ABFT Administrative Office. Forensic tOXicologists with a doctorate or masters degree who are interested in certification by the American Board of Forensic Toxicology should contact: ABFT Administrative Office, P.O. Box 669, Colorado Springs, CO 80901-0669 T..<>.lephone: 719-636-11 00 ~ DRUGS IN THE NEWS: A REVIEW OF HEROIN - A New Epidemic?

Submitted by: Vincent M. Papa, Ph.D. Air Force Drug Testing Laboratory, Brooks AFB, Texas 78235

Recently television newsmagazines such as 20-20 and Dateline, and newspapers throughout the country (U~. . Today, etc. ) have focused attention on a new heroin epidemic. In Plano, Texas (a suburb of Dallas), eight teenagers and young adults had deaths linked to heroin during a recent six-month period. DEA reports have highlighted influx of certain types of heroin. The use of heroin in the United States is on the rise according to federal sources (deaths occurring in the teenage population have focused public attention to the problem). After nearly two decades in which the number of addicts was stable at about 500,000, that number has grown to at least 600,000. According to the latest statistics, an increasing number of 8th, 10th and 12th graders have used heroin. The number of emergency room episodes due to heroin intoxication have increased steadily in the years 1990 to 1995 and the percent of arrested adults on heroin or other opiates has increased in the major metropolitan areas. Heroin (diacetylmorphine) was first synthesized from morphine and is now classified in the USA as a Schedule 1 drug. Worldwide, it has been used in such mixtures as Brompton's Cocktail and has been administered to addicts on a controlled basis. In the 1960's, the number of heroin addicts rose dramatically. The cheap price of heroin and its easy availability were major contributors to its increased use. A new form of Mexican heroin called black tar is reported to be 40 times more potent (based on heroin content) than traditional forms of heroin and has been responsible for many deaths nationwide. Heroin use in some areas of the southern United States is multigenerational with the sons of fathers and grandfathers often addicted. Illicit heroin varies in chemical and physical appearance between different countries or regions of origin. The percentage of heroin, acetylcodeine, 6 acetylmorphine, noscapine, papaverine and the color of samples have been used to classify heroin's origin as Southeast Asia, India, Pakistan, Iran, Turkey, Mexico, Near East, or Nigeria. Some heroin of Middle East origin is £12 % pure. This is in stark contrlidocaine, mannitol, dextrose, lactose, talc and baking soda). A single dose unit consisting of 3 - 16 mg of heroin can be less than $ 10. Throughout the years when the cost of heroin increased or street supply of heroin was drastically diminished, many drug addicts have used substitutes including T's a~ Blues (Tripelennamine and Pentazocine) and Loads (Glutethimide and Codeine) . Over the years, a number of researchers have studied heroin pharmacokinetics. Tress et al. demonstrated that a 5-mg intravenous heroin injection resulted in a plasma morphine concentration of 0.035 mg/L after 25 minutes and a 13 mg intravenous injection resulted in an increase to 0.082 mg/L of plasma morphine concentration in a heroin dependent subject (1). Cone showed that nasal insufflation of 12 mg of heroin by 6 adults produced plasma levels averaging 0.016 mg/L heroin at 0.08 hours, 0.014 mg/L 6-acetylmorphine at 0.08-0.17 hours and 0.019 mg/L morphine at 0.018-1.5 hours, with elimination half lives averaging 0.07, 0.22 and 2.8 hours, respectively (2) . Heroin has high lipid solubility and rapidly passes through the blood brain barrier. In vitro studies (3) have shown that heroin is rapidly deacetylated in whole blood to 6-acetylmorphine (half-life, 9 minutes), and 6-acetylmorphine is further hydrolyzed to morphine at a slower rate (half-life, 38 minutes). The first reaction is catalyzed by blood esterases while the second occurs in the liver. Olendorf (4) clearly showed that the percentage uptake of heroin by rat brain tissue was 68 % after intra-arterial injection of heroin in rats. This is significantly higher than for methadone and codeine. In his studies, Way (5) indicates that heroin persists in the brain for a few minutes, whereas 6-acetylmorphine and morphine are present in the brain for up to 30 minutes. Furthermore, others have demonstrated that heroin has little affinity for the opiate brain receptor; consequently, 6-monoacetylmorphine, morphine and morphine 6-glucoronide are responsible for the effects of heroin (6). While complications of intranasal abuse among teenagers as shown in the Dateline and ABC television presentations are few, chronic intravenous abuse may result in liver disease, pulmonary hypertension and peripheral nerve lesions (7,8,9). Postmortem fluid and tissue concentrations of morphine in victims of heroin overdosage can vary considerably depending upon the prior narcotic history of the subject. Liver, bile, kidney and urine concentrations (expressed as total morphine) may be more representative of past exposure to the drug, while blood concentrations expressed as free morphine may be more representative of recent exposure. Baselt (10) and Garriott (11) demonstrated that interpretation of the effects of heroin adm.inistration from absolute postmortem blood morphine concentrations can present a problem because concentrations of addicts dying from traumatic causes like gunshot wounds and vehicular accidents were shown to be equal or greater than overdose situations. It is, therefore, highly suggested that the forensic pathologist carefuUy consider all the case data before rendering a cause of death determination. Immunoassays such as the EMIT, RIA and On-Line assays have limited cross reactivities to heroin a 6-monoacetylmorphine. The RIA assay has a cross reactivity of 156% for codeine and ethylmorphine with significantly low,-. reactivities for 6-acetyl morphine (80%), dihydromorphine (73 %) and 3-morphine glucuronide. However, the Roche On-Line assay has a cross reactivity of 199% and 178% for codeine and dihydrocodeine, and cross reactivities of 80% and 73% for 6-acetylmorphine and dihydromorphine, respectively. Forensic and other laboratories use 6-MAM as a marker for heroin use.

ToxTnlk Volume 22. No.2 JURe 1998 (Page 8) Copyright 1998 Many researchers have developed gas chromatographic assays for heroin and it's metabolites using flame-ionization, nitrogen-phosphorus and electron-capture detectors. Wu-Chen and others developed more specific tests (12) using gas chromatographic-mass spectrometric methods for biological specimens that are subjected to acid or enzyme hydrolysis. Linear ranges are 1 ng/ml to over 100 ng/ml. High Pressure Liquid Chromatographic (HPLC) methods have appeared in the !rature allowing for the simultaneous determination of heroin metabolites and their conjugate~ .

References:

1. K. H. Tress, A. A. EI-Sobky, W. Aherne and E. Piall. Degree of tolerance and the relationship between plasma morphine concentration and pupil diameter following intravenous heroin in man. BritJ.Clin.Pharm.5: 299-303,1978. 2. E. J. Cone, B. A. Holicky, T. M. Grant et al. Pharmacokinetics and pharmacodynamics of intranasal heroin. J. Anal Tox. 17: 327- 337,1993. 3. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning, Second Edition, 427- 431, 1997 4. W. H. Olendorf, S. Hyman, L. Braun et al. Blood-brain barrier: penetration of morphine, codeine, heroin and methadone after carotid injection. Science 178: 984 - 986, 1972. 5. E. L. Way, J. W. Kemp, J. M. Young et al : The pharmacologic effects of heroin in the relationship to its rate of biotransformation. J.Pharm.Exp.Ther.129: 144 -154,1960. 6. C. E. Intrussi, M. Schultz, S. Shin et al. Evidence from opiate binding studies that heroin acts through its metabolites. Life Sci. 33 (SuppI.1): 773-776,1983. 7. E. E. Force and J. W. Millar. Liver disease in fatal narcotism. Arch. Path. 9: 166-170, 1974. 8. R. S. Kurtzmann. Complications of narcotic addiction. Radiology 96: 23-30,1070. 9. R. W. Richter, J. Pearson and B. Brun. Neurological complications of addiction to heroin. Bull. N.Y. Acad.Med.49: 3-21, 1973. 10. R. C. Baselt, D. J. Allison, J. A. Wright et al. Acute heroin fatalities in San Francisco - demographic and toxicologic characteristics. West J. Med. 122: 455-458,1975. 11 . J. C. Garriot and W. Q. Sturner. Morphine concentrations and survival periods in acute heroin fatalities. New Eng.J.Med.289: 1276-1278, 1973. 12. N. B. Wu Chen, M. I. Shaffer, R. I. Lin and R. J. Stein. Simultaneous quantitation of morphine and codeine in biological samples by electron impact mass fragmentography. J. Anal. Tox. 6: 231-234,1982

The author gratefully acknowledges the support and helpful comments of James J.Kuhlmann, Ph.D. The opinions expressed herein are strictly those of the author and are not to be construed as reflecting the Views, policies, or positions of the Department of the Air Force or the Department of Defense. ~

NUMBER CRUNCHING: SOFT ROSTER

Full: 420 Charter: 25 Associate: 88 Student: 10 Retired: 19 TOTAL: 562 ~

Technical Notes: BLUTALKOHOLKONZENTRATION No. 21

Submitted by: J. G. Wigmore, B. Sc., Toxicology Section, Centre of Forensic SCiences, Toronto, Ontario, Canada

The Effect of Hypersalivation on the Breath Alcohol Concentration M. Tsokos and N. Bilzer. Blutalkohol, 34:405-412, 1997. German title: Zum Einfluss von Hypersalivation auf die Atemalkoholkonzentration

Seven female and 8 male subjects (ages 21-30 yrs) consumed 0.6 g/kg ethanol within 25 mins. after a 6-hr fast. Blood and breath samples were collected at 30, 50, 70, and 90 minutes after the end of drinking. BACs were determined by ADH and GC methods and BrACs by the Sieman's Alcomat, an IR instrument. The BrACs were determined before and after forced hypersalivation. The hypersalivation was induced by rinsing the outh with 15 mL of 100% lemon juice or by dabbing the sour taste buds with 0.5 mL of citric acid. At 30 mins. the mean cAC was 0.079 g/100mL, the mean BrAC (before hypersalivation) was 0.074 g/100mL, and the mean BrAC (after hypersalivation) was 0.063g/1 OOmL. The Authors conclude that the slight reduction in BrAC after hypersalivation is due to the diffusion of alcohol from ~f " breath into the saliva during exhalation. ~

Hoogerkamp, A., Arends, R. H., Bomers, A. M., Mandema, J. W., Voskuyl, R. A. and Danhof, M. Pharmacokinetic/pharmacodynamic relationship of benzodiazepines in the direct cortical stimulation model of anticonvulsant effect Journal of Pharmacology & Experimental Therapeutics 279 (2): 803-812 1996 Gedney, J. A. and Ghosh, S. Pharmacokinetics of analgesics, sedatives and anaesthetic agents during cardiopulmonary bypass. [Review] [74 refs] British Journal of Anaesthesia 75 (3): 344-351 1995

Frantz, S. W., Beskitt, J. L., Grosse, C. M., Tallant, M. J., Dietz, F. K. and Ballantyne, B. Pharmacokinetics of ethylene glycol. I. Plasma disposition after single intravenous, peroral, or percutaneous doses in female Sprague-Dawley rats and CD-1 mice Drug Metabolism & Disposition 24 (8): 911-9211996 Hayball, P. J., Wrobel, J., Tamblyn, J. G. and Nation, R. L. The pharmacokinetics of ketorolac enantiomers following intramuscular administration of the racemate British Journal of Clinical Pharmacology 37 (1): 75-781994 Greenblatt, D. J. The pharmacology of benzodiazepines: comments on terminology and sources of data Psychopharmacology 118 (2): 120-1211995 Flanagan, R. J. The pOisoned patient: the role of the laboratory British Journal of Biomedical Sciences 52 : 202-213 1995 van Wijngaarden, M., Cushing, B., Kerns, T. and Dischinger, P. Police perception of intoxication among injured pedestrians Journal of Emergency Medicine 13 (1): 21-261995 Tulloh, B. R. and Collopy, B. T. Positive corre'lation between blood alcohol level and ISS in road trauma Injury 25 (8): 539-543 1994

Robertson, M. D. and Drummer, O. H. Postmortem drug metabolism by bacteria Journal of Forensic Sciences 40 (3): 382-386 1995 Schuberth, J. Post-mortem test for low-boiling arson residues of gasoline by gas chromatography-ion-trap mass spectrometry Journal of Chromatography B: Biomedical Applications 662 (1): 113-117 1994 George, S. and Braithwaite, R. A. A preliminary evaluation of five rapid detection kits for on site drugs of abuse screening Addiction 90 (2): 227-232 1995 Staub, C., Lacalle, H. and Frye, O. [Presence of psychotropic drugs in the blood of drivers responsible for car accidents, and who consumed alcohol at the same time] Sozial- und Praventivmedizin 39 (3): 143-149 1994 Liu, S., Siegel, P. Z., Brewer, R. D., Mokdad, A. H., Sleet, D. A. and Serdula, M. Prevalence of alcohol-impaired driving. Resu'lts from a national self-reported survey of health behaviors Jama 277 (2): 122-125 1997 Matsuki, Y. [Progress in mass spectrometric analysis of steroid conjugates--LC/MS and MS/MS]. [Review] [18 refs] [Japanese] Nippon Rinsho Japanese Journal of Clinical Medicine 52 (3): 666-671 1994 Bittmann, K. [Proof of alcoholic intoxication in automobile driving by breath alcohol content in Austria from the legal viewpoint] Blutalkohol 30 (6): 344-348 1993 Apple, F. S., Googins, M. K. and Resen, D. Propylene glycol interference in gas-chromatographic assay of ethylene glycol [letter] [see comments] Clinical Chemistry 39 (1): 167 1993 Freeman, R., Sisson, P. R. and Heatherington, C. S. Pyrolysis mass spectrometry Methods in Molecular Biology 46 : 97-1051995 Cairns, E. R., Dent, B. R., Ouwerkerk, J. C. and Porter, L. J. Quantitative analysis of alprazolam and triazolam in hemolysed whole blood and liver digest by GC/MS/NICI with deuterated internal standards Journal of Analytical Toxicology 18 (1) : 1-6 1994 Maruyama, K., Takatsu, A. and Obata, T. The quantitative analysis of inhalational anaesthetics in forensic samples by gas chromatography/mass spectrometry/selected ion monitoring Biomedical Chromatography 9 (4): 179-182 1995 Wilkins, D., Rollins, D. E., Seaman, J., Haughey, H., Krueger, G. and Foltz, R. Quantitative determination of codeine a. its major metabolites in human hair by gas chromatography-positive ion chemical ionization mass spectrometry: a clinical application Journal of Analytical Toxicology 19 (5): 269-274 1995

ToxTalk , 'olllme 22, No.2 Jmu.'1998 (Pagl' 10) Coovril!ht 199R JOURNAL CLUB continued

Gupta, S. P. and Mulchandani, V. Quantitative structure-activity relationship studies on benzodiazepine receptor -binding: investigation of interaction model Indian Journal of Biochemistry & Biophysics 30 (3): 181-186 1993 _i , S. H., Chiang, C. N. , Tai, B. C., Marschke, C. K. and Hawks, R. L. Quantitative versus qualitative urinalysis for benzoylecgonine in clinical trials for the assessment of cocaine use Psychopharmacology Bulletin 31 (4) : 671-679 1995 Brandl, M., Conley, D. , Johnson, D. and Johnson, D. Racemization of ketorolac in aqueous solution Journal of Pharmaceutical Sciences 84 (9): 1045-1048 1995

Otsubo, K., Seto, H., Futagami, K. and Oishi, R. Rapid and sensitive detection of benzodiazepines and zopiclone in serum using high-performance thin-layer chromatography Journal of Chromatography B: Biomedical Applications 669 (2): 408-412 1995 Aarstad, K., Dale, 0 ., Aakervik, 0 ., Ovrebo, S. and Zahlsen, K. A rapid gas chromatographic method for determination of ethylene glycol in serum and urine Journal of Analytical Toxicology 17 (4): 218-221 1993 Meatherall, R. Rapid GC-MS confirmation of urinary amphetamine and methamphetamine as their propylchloroformate derivatives Journal of Analytical Toxicology 19 (5): 316-322 1995

Blandford, D. E. and Desjardins, P. R. A rapid method for measurement of ethylene glycol Clinical Biochemistry 27 (1): 25-301994 Coudore, F., Alazard, J. M., Paire, M., Andraud, G. and Lavarenne, J. Rapid toxicological screening of barbiturates in plasma by wide-bore capillary gas chromatography and nitrogen-phosphorus detection Journal of Analytical Toxicology 17 (2): 109-113 1993 Romberg, R. W. and Past, M. R. Reanalysis of forensic urine specimens containing benzoylecgonine and THC-COOH Journal of Forensic Sciences 39 (2): 479-485 1994

Gorelick, D. A. Recent developments in alcoholism:pharmacological treatment Recent Developments in Alcoholism 11 : 413-427 1993 ooft, P. J. and van de Voorde, H. P. Reckless behaviour related to the use of 3,4-methylenedioxymethamphetamine (ecstasy): apropos of a fatal accident during car-surfing International Journal of Legal Medicine 106 (6) : 328-329 1994 Cone, E. J. and Huestis, M. A. Relating blood concentrations of tetrahydrocannabinol and metabolites to pharmacologic effects and time of marijuana usage. [Review] [23 refs] Therapeutic Drug Monitoring 15 (6): 527-532 1993

Brickley, M. R. and Shepherd , J. P. The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients Injury 26 (5) : 311-3141995 Schyma, C. and Schyma, P. [Reliability of back-calculation of blood alcohol concentration to the time of infraction] Blutalkohol 33 (2): 65-70 1996 Fishbain , D. A. Report on the prevalence of drug/alcohol abuse and dependence in chronic pain patients (CPPs) [letter] Substance Use & Misuse 31 (8) : 945-946 1996 Bratzke, H. , Mebs, D., Schmidt, K., Koster, F. and Freier, H. [Reporting and evaluation and a blood alcohol laboratory--automated by using a new databank system] Blutalkohol 30 (3): 178-1881993 Pope, H. G., Jr. and Yurgel'un-Todd, D. The residual cognitive effects of heavy marijuana use in college students [see comments] Jama 275 (7) : 521-527 1996) Poklis, A. and Moore, K. A. Response of EMIT amphetamine immunoassays to urinary desoxyephedrine following Vicks inhaler use The'rapeutic Drug Monitoring 17 (1): 89-94 1995 Robertson, M. D. and Drummer, O. H. Responsibility analysis: a methodology to study the effects of drugs in driving Accident Analysis & Prevention 26 (2): 243-247 1994 ,J?rewer, R. D., Morris, P. D., Cole, T. B., Watkins, S., Patetta, M. J. and Popkin, C. The risk of dying in alcohol-related utomobile crashes among habitual drunk drivers New England Journal of MediCine 331 (8): 513-517 1994 Attah Johnson, F. Y., Hills, B. and Posanau, C. S. Roadside driver alcohol survey and hospital alcohol survey in Port Moresby, Papua New Guinea Medicine & Law 14 (3-4): 157-161 1995

ToxTalk Voillme 22. No. 'Z June 1998 (Page II) COPc-Tight 199R ELMER GORDON OPEN FORUM AN OPPORTUNITY FOR INFORMAL DIALOGUE

MAKE A COpy OF THIS PAGE and take it to your "Significant Other"

SO-SOFT: Considering bringing your SO (Significant Other) to Albuquerque? Some SOFT members have brought their spouses or other guests to SOFT Annual Meetings, and many of these SO's have developed rewarding relationships among each other as they banned together to enjoy themselves while you were attending meetings. If your SO-SOFT will be attending the Albuquerque meeting and would like to hang out with the group, have her/him contact Pat Monforte via [email protected] or ToxTalk. Pat is the self-appointed matriarch of SO-SOFT by virtue of seniority (Albuquerque will be her 20th consecutive SOFT meeting). [Repeated from last issue.]

ATTENTION A.B.F.T. DIPLOMATES AND FORENSIC TOXICOLOGY SPECIALISTS: The ABFT Annual Breakfast wi" be held on Thursday, October 8th, during the SOFT meeting. You may register on the new SOFTfTlAFT Meeting registration form in this issue of ToxTalk. If you have already registered for the meeting, send a second registration for the breakfast only. Only persons currently certified by the American Board of Forensic Toxicology may attend.

CHECK YOUR 1998 SOFT DIRECTORY. A few copies have missing pages. If your copy is incomplete, contact the SOFT Administrative Office at 602-839-9106 (phone or fax). ~

CAREER OPPORTUNITIES

Positions available are listed for the consideration of SOFT members. There is no fee for this service. The information will be repeated in the next issue only if the information is confirmed by the person who submitted it. If you have a job position available, FAX (602-595-6663) or E-MAIL ([email protected]) to ToxTalk or mail to: Dr. Joseph Monforte, ToxTalk Editor 42408 N. Sombrero Rd., Cave Creek, AZ 42408-2821.

Forensic Toxicologist: PharmChem Labs, Menlo Park, CA, has immediate opening for Ph.D., ABFT or ABCC-Tox certified or eligible. Generous compensation relative to experience. Relocation package available. Great career opportunity for qualified candidates. Contact Neil Fortner 800-446-5177 x217 or e-mail: [email protected]

Forensic Toxicologist: Dept Criminal Justice Services, Div of Forensic Sci, Roanoke, VA, seeks PhD. in toxicology or related, approved field; ABFT Diplomate or eligible required; expert witness experience preferred. Must have valid driver's license and pass background security check. Employee must provide own transportation for required overnight travel. For application form (#10-012) and further information, contact Gene Colburn 804-786-8730 or web page www.state.va .us/-dcjs/forensic/ ~

PROFESSIONAL CALENDAR

SOFT MEETING: October 5-9, 1998, SOFT/TIAFT, Albuquerque, New Mexico. Co-Hosts Drs. NGS Rao and Ronald Backer. For information contact Dr. NGS Rao, 505-841-2562, FAX: 505-841-2543, e-mail: [email protected].

FUTURE SOFT MEETINGS: 1999: San Juan, Puerto Rico 2000: Milwaukee, WI 2001 : New Orleans, LA

American Academy of Forensic Sciences (AAFS) annual meeting: February 15-20, 1999, Orlando, FL; February 21-2 ...... 2000, Reno, NV. Contact Brenda Papke, 719-636-1100. ~

URGENT NEWS

The Albuquerque Hilton is fully booked. Some rooms remain at the Fairfield Inn (next doorto the Hilton) and the Mountain View Holiday Inn (across the street from the Hilton).

Please call the hotels directly and ask for the front desk reservations. Refer to the SOFT/TIAFT meeting to receive the discounted rates.

Fairfield Inn (505) 889-4000

Mountain View Holiday Inn (505) 884-2511 SOFT/TIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA

PROGRAM UPDATE - JUNE 1998

SATURDAY,3 OCTOBER 1998 Pre-Conference Tours: Acoma Pueblo; City Tour/Indian Cultural Center; Sandia Peak Tram Ride and Mountain Trails; Jemez Springs Mountain Area; Bandelier National Monument. CAP Inspector's Workshop

SUNDAy, 4 OCTOBER 1998 Pre-Conference Tours: Balloon Festival Mass Ascension at Dawn; Albuquerque City Tour (morning) Workshops: TIME: 1:30 P.M. TO 5:30 P.M. Workshop # S I Expert Witness Testimony: Aspects from Other Nations, M. Corbett, Ph.D. Workshop # S2 Is Hair Analysis Racially Biased, D. Kidwell, Ph.D. SAMHSA NLCP Inspector's Workshop, Sunday Evening

MONDAY, 5 OCTOBER IH8 Time: Workshops 1, 2 & 7 - 8:00 A.M. to 12:00 Noon Workshop # I Pharmacology and Analytical Toxicology of Drugs in Saliva Workshop # 2 Current Applications of Thin Layer Chromatography in Forensic Toxicology Workshop # 7 Rohypnol Detection, S. Salamone, Ph.D. Time: Workshops 3, 4 & 5 -: 1 :30 P.M. to 5:30 P.M. Workshop # 3 Analytical and Interpretive Challenges with Amphetamine Analogs Workshop # 4 Practical Aspects ofCIIMS for Drugs of Abuse Analysis Workshop # 5 Case Histories In Forensic Pathology. Welcommg Reception

TUESDAY, 6 OCTOBER 1998 Workshop # 6 Medical Traditions in the Four Cultures: "Herbs of the Curanderos" at Rancho de las Golondrinas and "The Scalpel and the Silver Bear" in Santa Fe. Free afternoon in Santa Fe

WEDNESDAY,70CTOBERl~8 Plenary Session Scientific Sessions, Oral and Poster Exhibits Open Presidents Reception and Buffet Dinner Elmer Gordon Forum

THURSDAY,8 OCTOBER 1998 ABFT Annual Breakfast Scientific Sessions, Oral and Poster Exhibits Open

FRIDAY,9 OCTOBER 1998 Scientific Sessions, Oral and Poster SOFT Business Meeting TIAFT Business Meeting Farewell Banquet

SATURDAY, 10 OCTOBER 1998 Post Congress Tours: Taos Pueblo; White Sands and Carlsbad Caverns SOFT/TIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA

WORKSHOP ABSTRACTS

SATURDAY, 3 OCTOBER 1998 TIME: 3:00 PM TO 9:00 PM

COLLEGE OF AMERICAN PATHOLOGIST (CAP) FUDT INSPECTOR WORKSHOP REGISTRATION WILL BE 2 PM TO 3 PM, CONTACT NANCY LOWE AT 847-832-7470 FOR ADDITIONAL INFORMATION.

SUNDAY, 4 OCTOBER 1998 TIME: 1:30 PM TO 5:30 PM

WORKSHOP #SI - EXPERT WITNESS TESTIMONY: ASPECTS FROM OTHER NATIONS This workshop Is based on the principle that other nations have differing cultures that evolve unique legal systems. Therefore, forensic toxicologists in other nations have differing approaches In conducting their examinatIons and presenting evidence as an expert In their judicial forum. Presentations will be made by forensic toxicologists from other nations about their practices, current developments, and aspects of recent InfluentIal cases. The workshop will conclude with a panel discussion, including some audience partIcipatIon. SUNDAY, 4 OCTOBER 1998 TIME: 1:30 PM TO 5:30 PM

WORKSHOP IS2 - IS HAIR ANALYSIS RACIALLY BIASED? Testing hair for drugs of abuse Is becoming Increasingly popular in both the forensic and commercial sectors. Within the past few years, concerns have been raised that hair testing could be affected by a matrix bias with black hair absorbing and retaining more drugs than lighter colored hair. Under certain experimental conditions, differences in concentrations of cocaine In vartous hair types were especially pronounced and this has been attributed to binding of the cocaine to melanin. Because of this effect, darker haired individuals may be more readily identified a6 drug users by hair analysis than individuals with lighter colored hair. In contrast to these stUdies, other have reported that no bias Is observed In actual practice, Thus there is disagreement in the scientific literature on this subject. For this workshop, ten leading scientists, active in hair ana/ysla. research, will present a short summary of their results on the effects of hair type on drug Incorporation. A balance of Individuals from both the academic, governmental, and commercial arenas will participate. These presentations will be followed by a roundtable dlscuS8lon where the audience will have the opportunity to comment and raise questions. The outcome of the roundtable dlscuBsion will be a set of recommendations in two areas (1) does racial bias exist? (2) if it exists, what procedures can be employed In the testing laboratories to level the playing field . This workshop is underwrttten in part by the Division of Workplace Programs at the Substance Abuse and Mental Health Services Administration and will be transcribed. The verbatim transcript will be made available on their world wide web site at www.health.org/pub~dtab.h~m !!lIang with ('ther discussion on hair analysis. SUNDAY, 4 OCTOBER 1998 TIME: SUNDAY EVENING

SAMHSA NLCP INSPECTORS WORKSHOP: OPEN ONLY TO NLCP INSPECTORS AND REQUIRES PRE-REGISTRATION CONTACT DONNA BUSH, Ph.D., AT 301-443-6014.

MONDAY, 5 OCTOBER 1998 TIME: 8:00 AM TO 12:00 NOON

WORKSHOP #1 - PHARMACOLOGY AND ANALYTICAL TOXICOLOGY OF DRUGS IN SALIVA

Saliva has been proposed and evaluated as an alternate biological specimen for drug analysis. A major challenge with this matrix has been its limited quantity, low analyte concentration and short surveillance window (detection time). This workshop will present pharmacokinetic and pharmacodynamic data for a variety of drugs of abuse and nicotine in controlled dosing studies. In addition, empirical data from the life and health insurance industry will be presented. Also, incorporated into these presentations, will be an overview of the analytical methodologies utilized in these studies.

MONDAY, 5 OCTOBER 1998 TIME: 8:00 AM TO 12:00 NOON

WORKSHOP #2 - CURRENT APPLICATIONS OF THIN-LAYER CHROMATOGRAPHY IN FORENSIC TOXICOLOGY Thin-layer chromatography provides a powerful tool to the toxicologist for screening or conflnnlng drugs and drug metabolites In forensic or clinical samples. The workshop will present this rather simple technique from extraction to detectIon. and how It can compete In 'soMng QuesUons that .are probiematIo for other Instrumental chromatographic methods. Separation. and IdentificatIon of many different 8ympathomornetic amines, opiates Will be featured along with dlsaJsslon of computer augmented IdenUftcatJon of TLC dats.

MONDAY, 5 OCTOBER 1998 TIME: 8:00 AM TO 12:00 NOON

WORKSHOP #7 - ROHYPNOL DETECTION There has been a recent surge of interest in the U.S. and countries of Central and Westem Europe in the detection of flunitrazepam (Rohypnol) in alledged "date" rape cases. This workshop will cover aspects of the pharmacodynamics and pharmacokinetics of flunitrazepam.

Highlights:

• Exoretlon pattems of ftunltrazepam In patients who have taken low, medium and high doses

• Methods to Increase Immunoassay sensttlvity

• GC/MS procedures to Identify flunltrazepam

• Results from a nationwide case study on the use o( flunltrazepam and other drugs in alledged -date" rape cases . MONDAY, 5 OCTOBER 1998 TIME: 1:30 PM TO 5:30 PM

WORKSHOP #3 - ANALYTICAL AND INTERPRETIVE CHALLENGES WITH AMPHETAMINE ANALOGS

Analysis of Amphetamine analogs remains one of the more difficult assays in forensic toxicology. This workshop will review some old and new methods of analysis and d,l isomer differentiation. Actual forensic cases both post-mortem and employee drug testing will be presented.

MONDAY, 5 OCTOBER 1998 TIME: 1:30 PM TO 5:30 PM

WORKSHOP #4 - PRACTICAL ASPECTS OF CI/MS FOR DRUGS OF ABUSE Chemical Ionization Gas Chromatography Mass Spectrometry (CI-GC-MS) has become increasingly popular in the forensic t~xlcology labOratory due to the advent of bench-top systems, increased sensitivity over electron impact procedures, and ease of molecular ion identification. This workshop will include practical advice on setting up both posltlve and negative ion chemical Ionlzatlon sY8tem8, discuss the advantages and disadvantages of CI-GC-MS and include applications such 8S the determination of drugs of abuse in alternative matrices, IdentifICation of doping agents and detedlon of compounds used In drug abuse treatment. Attendees should gain practical Information applicable to operation of their own Cllnstruments.

MONDAY, 5 OCTOBER 1998 TIME: 1:30 PM TO 5:30 PM

WORKSHOP #5 - CASE HISTORIES IN FORENSIC PATHOLOGY AND TOXICOLOGY

Case histories in Forensic Pathology and Toxicology will be presented and discussed by forensic pathologist. The circumstances of death and selected autopsy and toxicology results will be available in the form of case histories for review by the workshop participants in adVance of the workshop. Each case history will have questions for the participants to consider prior to the discussion and analysis by the forensic pathologists. These cases present diagnostic or interpretive difficulties and dilemmas confronting forensic pathologist in determining cause and manner of death.

TUESDAY 6 OCTOBER 1998 TIME: 8:00 AM TO 5:30 PM

WORKSHOP #6 - MEDICAL TRADITION IN THE FOUR CULTURES

The workshop will be held in Santa Fe, New Mexico and registration includes round trip transportation and continental breakfast and lunch. In the morning attendees will hear lectures on "Herbs of the Curanderos" and "The Scalpel and the Silver Bear" combining Western and Traditional Navajo medicine. The afternoon will be free time to walk, shop and/or visit museums in Santa Fe. SOFT/TIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA

Registration Information There are two types of registrations: the Sandia Registration and the Mesa Registration. The Mesa RegistratIOn is a basic fee in keeping with traditional SOFT meetings. The Sandia Registration is an all-inclusive fee in keeping with traditional TIAfT meetings. Both types of registrations are fully described below. There is also a description of Workshop # 6 and the Accompanying Person Registration. Everyone has the choice to choose either registration regardless of membership. Attendees using the Mesa Registration may purchase the accompanying persons registration package on the Sandia Registration form or any individual tickets as desired.

Mesa Registration The basic meeting registration includes admission to all scientific sessions, copy of Abstracts book, the Welcoming Reception, the Presidents Reception and buffet dinner, Thursday Luncheon and all coffee breaks.

Sandia Registration The basic meeting registration includes admission to all scientific sessions, copy of the Abstracts book. the Welcoming Reception. the Presidents Reception and buffet dinner, the Wednesday, Thursday and Friday Luncheons, the Farewell Banquet, Workshop # 6, the published Congress Proceedings and all coffee breaks.

Accompanying Persons Registration This registration includes the Welcoming Reception, the Presidents Reception and buffet dinner, the Banquet and Workshop # 6 (trip to Santa Fe).

Workshop # 6 This workshop, "Medical Traditions in the Four Cultures" includes round-trip transportation, morning lectures on Herbs and Plants of the Curenderos at Rancho de las Golondrinas and on combining Western and Traditional Navajo medicine in Santa Fe, continental breakfast and lunch. The afternoon will be free to walk, shop or visit museums in Santa Fe.

Payment Deadlines A late fee of $50 will be charged on all registration received after August I, 1998. No mail registrations accepted after September 7. 1998. Payment by credit cards or business checks drawn on a USA bank, International Bank Check or Money Order. All funds must be paid in US dollars. Make payable to SOFT/TIAFT 98. Cancellation of Registration: 70% refund if canceled prior to July 10, 1998; 50% refund if canceled prior to Sept. 7 1998: No refund ifcanceled after Sept. 7,1998.

Hotel Reservations and Air Reservations for rooms should be made directly with the hotel. Because the meeting is being held during the week of Balloon Festival attendees are advised to reserve rooms and flights as early as possible. After July 1 no accommodations can be assured. Early departure fees possible. Contact Fairfield Inn at (505) 894-4000 and ask for Front Desk Reservations or Mountain View Holiday Inn at (505) 884-2511 and ask for Front Desk Reservations. For conference rates specify SOFT. American Airlines is offering attendees a 5% discount on domestic fares. Call 1-800-433-1790 and refer to TIAFT ABQ group name and "AN NUMBER" 5708UA.

Tour Reservations Requests for Pre- and Post Conference Tours will be forwarded to the local tour companies. The Conference organizers -~ take no responsibility for pre- or post-conference tours. Tour companies pick up at the Albuquerque Hilton Hotel. SOFTITIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA Mesa Registration

NAME______.Degree.______Last First Title/Agency ______Address______Telephone______Fax______Guest(s) ______E-mai.:...l______Member: SOFT---- TIAFT__ Both---- Non-Member----

SOFT/TIAFT NON TOTAL MEMBER MEMBER ENCLOSED Basic Meeting Registration includes admission to all scientific sessions, $125 $175 $_- Abstracts bonk. the Welcoming Reception, the Presidents Reception and buffet dinner. rhursday Luncheon and all coffee breaks. Workshop # 1 Phannacology and Anal. Tox. of Drugs in Saliva $40 $75 $_- Workshop # 2 Current Applications ofTLC in Forensic Toxicology $40 $75 $_- Workshop # 3 Analytical Challenges with Amphetamine Analogs $40 $75 $_- Workshop # 4 Practical Aspects of CI-MS for Drugs $40 $75 $_- Workshop # 5 Case Histories In Forensic Pathology $40 $75 $_- Workshop # 6 Traditional Medicine in the Four Cultures $75 per person x __ people $_- Workshop # 7 Rohypnol Detection $40 $75 $_-- Workshop #S 1 Expert Witness Testimony: Aspects from Other Nations $40 $75 $----- Workshop #S2 Is Hair Analysis Racially Biased $40 $75 $----- ABH Breakfast (Diplomats Only) $20 $20 Full-Time Student or Daily Registrant Permits attendance at $30 $50 $_- scientific sessions only Wed, Thurs, or Friday. Fee is per each day. Published Congress Proceedings $30 $40 $_-- Extra Tickets: Welcoming Reception $25 # of tickets $_-- Presidents Reception! Dinner (Wed.) $25 # of tickets $_- Farewell Banquet (Fri.) $40 # of tickets $_- Luncheon (Wed.) $20 # of tickets $_- Luncheon (Thurs.) $20 # of tickets $_- Luncheon (Fri.) $20 # of tickets $_-

Meeting T-Shirts ( free if registered by July 1) Large __ X-Large__ XXLarge___ $_- May nut be available after Aug 1,1998. $15 each for extra shirts. __# Extra Shirts

Late Fee: For all registrations received after Aug 1. 1998 $50 $_- No mail registrations accepted after September 7, 1998: Payment personal or business checks drawn on a USA bank, International Bank Checks or Money Order. All funds must be paid . in US dollars. Make payable to SOFT/TIAFT 1998. Total $ ___ For payment by credit card include: Type of Card: Visa I Master Charge Card No ------Expiration Date______Signature______

Mail to: SOFT/TIAFT 1998, PO Box 40711, Albuquerque, NM 87196-0711 USA SOFT/TIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA LODGING

Nalne______

Address______

City/State/ZIP Country______

Telephone # Fax # ______

Arrival DaylDate/Time Departure Day/Date ______(Please note check-in time of 3 pm) (Please note check-out time of 12 :00 pm)

Total number in party _____ Would you like to request a non-smoking room? Yes No There is no charge for children under 18 when they occupy the same room as their parents.

Please indicate Accommodations Requested:

- Fairfield Inn by Marriott Mountain View Holiday Inn 1760 Menaul Blvd., N.E. 2020 Menual Blvd., N.E. Albuquerque, New Mexico 87102 Albuquerque, New Mexico 87107 tel (505)889-4000 tel (505) 884-2511

No . of Rooms Rates No. ofRooms Rates Single Occupancy $ 89.00 Single Occupancy $ 99.95 Double occupancy $ 89.00 Double Occupancy $ 99.95 Triple occupancy $ 99.00 Triple Occupancy $109.95 Quad occupancy $109.00 Quad Occupancy $109.95

Bedding request (please circle) One bed Two beds Bedding request (please circle) One bed Two beds Spec ial request______Special request. ______

Please send deposit to hotel directly (See above for Hotel Address). Reservations must be guaranteed by a deposit, or an accepted credit card number and signature. Guaranteed by Check Credit Card Card Type: ______Credit Card # Expiration Date______

I understand that I am liable for one night's room and tax, which will be deducted from my deposit or credit card in the event that I do not arrive or cancel 72-hours in advance.

S ignature ______--:-______ALL RESERVATIONS MUST BE IN BY SEPTEMBER 3, 1998 Reservations recei ved after this date will not be guaranteed room availability or the conference rate. SOFT/TIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA Sandia Registration

NA~E ______Degree ______Last First Tit leiAgency ______Address______Telephone______Fax______Guest(s) E-mail______~ember: TIAFT SOFT___ Both.______Non-Member_____

SOFT/TIAFT NON TOTAL MEMBER MEMBER ENCLOSED

Bas ic Meeting Registration includes admission to all scientific sessions, $275 $325 $_-- .-\bSll'acIS bUIlk. Welcoming Reception. Presidents Reception and buffet dinner, \\'c

Accompanying Person Registration includes the Welcoming Reception, $175 $_- Preslel,'IlIS Reception and buffet dinner, the Banquet and Workshop # 6 (Santa Fe).

Extra Tickets: Welcoming Reception $25 # of tickets $---- Presidents Reception! Dinner (Wed.) $25 # of tickets $_- Farewell Banquet (Fri.) $40 # of tickets $_- Luncheon (Wed.) $20 # of tickets $_- Luncheon (Thurs.) $20 # of tickets $---- Luncheon (Fri.) $20 # of tickets $_-

Meeting T-Shirts ( free if registered by July 1) Large X-Large____ XXLarge____ $----- Mav Ilot be available after Aug I, 1998. $15 each for extra shirts. __# Extra Shirts

Late Fee: For all registrations received after Aug 1. 1998 $50 $--- No mail registrations accepted after September 7, 1998: Payment by personal or business checks drawn on a USA bank, International Bank Checks or Money Order. All funds must be paid in US dollars. Make payable to SOFT/TlAFT 1998. Total $ _____ For payment by credit card include: Type of Card: Visa I Master Charge Card No ______Expira tion Da te______

Signanlre______Mail to: SOFT/TIAFT 1998, PO Box 40711, Albuquerque, NM 87196-0711, USA SO FT ITIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA

Instructions for Abstract Preparation

General Instructions: Format of Abstract The program committee solicits abstracts on all forensic Abstracts must be typed and submitted in a neat legible toxicology topics, but is especially interested in papers on fonnat following the instructions and style provided in the the analysis of drugs and metabolites in alternative sample below. Type the entire abstract within the boxed biofluids and tissues such as hair, sweat, saliva, skin, area, single spaced with 12 point font. Type the title in \'Itreous. breast milk, meconium, etc. and in papers relating upper and lower case, followed by the author{s) names and drug concentrations to perfonnance impainnent, drug addresses. Use an Asterisk (*) to identify the presenting interactions, drug metabolism, phannacology and author. Separate the author(s) names from the body of the phannacokinetics. Platfonn presentations will be 15 min abstract by a single blank line. Indent each paragraph three including questions and Poster Presentations will be 4 ft spaces, Identify three key words at the bottom of the high by 3.25 ft wide, Tack boards and thumb tacks will be abstract. provided. An original and three copies of the abstract must be Notification of Acceptance submitted on the official abstract fonn. Please also submit All submitting authors will be notified of receipt of the the abstract on a computer disk or by attachment to an e abstract. Notification of acceptance of the abstract and mail message to [email protected]. Electronic submissions selection ofthe type ofpresentation will be mailed or -"st be in IBM word processing fonnat (MS Word for sent by fax or e-mail no later than September 1, 1998, .ndows preferred) or ASCII fonnat. Please label the disk with the first author's name and the word processing Specific Instructions program utilized, The deadline for submission of Complete the attached fonn and follow the sample 1998. The presenting authors of all abstracts is July 1, provided below. Proof-read all infonnation provided. Send papers will be required to register for the meeting. Only the original, three additional copies and an IBM disk with abstracts written in English will be considered. the abstract to: Content of Abstract Mailing Address: SOFT/TIAFT 1998 1. Author(s) names and addresses 422 Tustin Ave. 2. Short Specific Title 3. Statement of paper's objectives Newport Beach, CA 4. Statement of methods, if pertinent USA 92663 5. Statement ofresults 6. Statement of conclusion E-mail Address: [email protected] or [email protected] Sample Abstract: Title: Type Upper and Lower Case. Use Significant Words Descriptive of Subject Content

Author(s) Names and Addresses: Type Upper and Lower Case; Spell Out First and Last Names, Use Middle Initial. e.g, Vina R. Spiehler

--- Tndent each paragraph three spaces. Type the entire abstract within the boxed area, single spaced. Do not type in al "dpitalletters, Capitalize and punctuate exactly as you wish the abstract to appear in the program.

Key Words: Type three key words or phrases in upper and lower case, SOFT/TIAFT 1998 October 5-9, 1998 Albuquerque, New Mexico, USA

Abstract of Paper Deadline for Submission July 1, 1998

Presenting Author, Name and Mailing Address: Do you intend to submit the Full manuscript for inclusion in the PROCEEDINGS? ( ) YES () No Telephone:,______Has this paper been presented before? ( ) Yes( ) No Fax:______~------Where and When? ______E-mail address------Available Audio-visual Equipment: 35 mm slide projector and pointer. Presentation Preference: ( ) Oral ) Poster Affiliation: ( ) SOFT ( ) TIAFT ) Neither The abstract review committee reserves the right of fin al placement of the paper. The presenting authors of all Co-authors(s), Address( es), Business Affiliations papers are required to register for the meeting.

Signature of submitting author